Let us imagine a healthcare system in which patients are at the center. Where patients can visit different doctors or health centers without having to repeat their personal data or medical records; where their medical records are available to any professional if they want to get the complete picture; where the drugstores they go to are already aware of the medications they need, the dose, for how long they should take them and even send them a reminder for each take through an app.

Now let us imagine a healthcare system with all its different components –insurance companies, service providers, clinics, and governmental offices–interchanging data on services, visits, and reimbursements, to guarantee the maximum efficiency and optimize its ever-scarce resources.

All this is possible in the age of data and digital transformation. We only need to adopt new standards and integrate systems to interchange information. Interchange protocols will facilitate the way things are done; they will bolster the incorporation of processes based on best practices; and they will practically eliminate the volume of errors, something that is very frequent in an industry that insists on using paper as a format and manual data entry as a mechanism.

Evolution is not easy. Cultural, technology, and business barriers present a true challenge for the future.
Next, we will analyze the present situation faced by the sector and point out possible actions for the future that we will consider in greater detail in an upcoming article.

Cultural barriers and technology obstacles

There are governmental regulations to standardize and digitalize patient information. However, these regulations clash with the evolution of new technologies and concerns about the confidentiality of data, and personal security, all of which makes it complicated to implement them. This, in turn, generates a lack of consensus among companies in the sector. Without a firm regulatory umbrella, companies continue with business as usual.

Even when old standards such as Electronic Data Interchange (EDI) are used, they are not fully observed. Very often, the reason is that specific issues appear that are not contemplated in the structure (how to interchange information, how to handle records and reports) or the semantics (can be something as simple as the patient having three surnames and there are only two fields to enter them, or there is relevant information that is not included in the medical record but is pertinent to the case). Against this backdrop, companies invest to solve the issues and, at the same time, they deviate from the standard.

From the cultural point of view, there is the generalized idea that information originates and is completed at the doctor’s office. There is no reason to export it or expose it later.

Legacy systems may strongly impact the core of the business in many large healthcare organizations, which often leads them to adapt to what the systems can do. Additionally, there is a resistance to making changes where “things always worked well.”

From the ideal to the possible

Despite the above, standards and integration are the way forward for an industry that needs to be modernized. A fluid interchange of information will save companies a lot of money, not only on poorly executed transactions or error-induced reimbursements but also on the funds invested in conducting partial or short-sighted integrations or on the people assigned to deal with the errors.

The benefits of open standards include higher profitability, better patient experience, and process efficiency optimization. If that is to become visible, companies need to work with a long-term vision. Changes do not take place overnight.

Likewise, companies cannot expect a standard to be 100% perfect. In our experience with system integration in healthcare, we have concluded that companies need to weigh the factors that make the standards a good solution to move forward and finally perceive the added value contributed by the standard.

The first factor is that the standard should work for large corporations and small startups. The second factor is that the standard should be extensible and capable of being upgraded without “breaking up” with previous releases. The third factor is that the standard should be revised and modified regularly. The world is dynamic (medicine, in particular innovates at a hectic pace) so that the standard cannot be static. Lastly, the standard cannot be designed for the short term. The design, architecture, and scalability of the standard should necessarily be considered to support all the above factors.

Open standards and integration are the ideal remedies for the grief that has afflicted the healthcare industry: the inability to interchange information fluidly.